title: All-arthroscopic repair of arcuate avulsion fracture with suture anchor.
abstract: Arcuate avulsion fractures are very rare but present pathologic posterolateral rotation instability. Untreated instability may lead to overload of the reconstructed posterior cruciate ligament (PCL) graft. Surgical treatment and clinical results have not yet been reported to our knowledge. This study presents the case of a 45-year-old man with PCL injury and an arcuate avulsion fracture of the fibular head. The dial test was positive preoperatively, and magnetic resonance imaging showed an "arcuate" sign. The avulsed bone fragment was reduced and fixed with a suture anchor by an all-arthroscopic technique. At the 1-year follow-up, the patient had resumed all his normal activities, including sports. He scored 1+ on the posterior drawer test, and external rotation was 1° less than that in his contralateral normal knee. Compared with the values in the contralateral normal knee, the posterior tibial translation was reduced from 15.5 mm preoperatively to 6.3 mm postoperatively. The postoperative magnetic resonance imaging and computed tomography scans showed that the reconstructed PCL graft and the osseous fragment of the styloid process of the fibular head attached to the popliteofibular ligament were reduced. This technical note describes an all-arthroscopic reduction and fixation technique of arcuate avulsed fracture of the fibular head.
authors.affiliation: Sports Medicine Service, Beijing Jishuitan Hospital, Beijing, China.
authors.forename: Hui
authors.initials: H
authors.lastname: Zhang
authors.forename: Lei
authors.initials: L
authors.lastname: Hong
authors.forename: Xue-Song
authors.initials: XS
authors.lastname: Wang
authors.forename: Jin
authors.initials: J
authors.lastname: Zhang
authors.forename: Xin
authors.initials: X
authors.lastname: Liu
authors.forename: Hua
authors.initials: H
authors.lastname: Feng
mesh_terms: D000063:Accidents, Traffic; D001182:Arthroscopy / Q000379:methods*; D005360:Fibula / Q000293:injuries*; D005593:Fracture Fixation, Internal / Q000295:instrumentation / Q000379:methods*; D050723:Fractures, Bone / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D016268:Internal Fixators; D007593:Joint Instability / Q000209:etiology / Q000601:surgery; D008279:Magnetic Resonance Imaging; D008297:Male; D008592:Menisci, Tibial / Q000601:surgery; D008875:Middle Aged; D016119:Posterior Cruciate Ligament / Q000293:injuries / Q000601:surgery*; D020127:Recovery of Function; D053441:Suture Anchors; D013536:Suture Techniques; D000070600:Tibial Meniscus Injuries